Title: MODERN REHABILITATION PROGRAMS IN PHYSIOBALNEOTHERAPY OF LYMPHEDEMA OF LOWER EXTREMITIES.
1MODERN REHABILITATION PROGRAMS IN
PHYSIOBALNEOTHERAPY OF LYMPHEDEMA OF LOWER
EXTREMITIES.
- Apkhanova T.V., Badtieva V. A.
- Federal State Institution Russian Scientific
Center of Rehabilitation Medicine and Health
Resort Science of the Ministry of Health and
Social Development, Moscow, Russia. -
2In the general structure of a vascular pathology
lymphedema of lower extremities occupies
about 8-10 .
- lymphedema suffer about 120 million persons
in the World.(World Health Organization,2002). - In Moscow every tenth patient addressing for
the specialised help to phlebologist, suffers a
lymphatic odema of extremity.
3-a feeling of heaviness -cosmetic
deformity-slight discomfort-repeated episodes
of infection (cellulitis and lymphangitis) -
malignant degeneration (Stewart-Treves syndrome)
-thickening of the skin-hardening of the
limb-leakage of lymph -massive swelling
(elephantiasis)These conditions considerably
decrease the quality of a life.
- The problems for patients with Lymphedema
4Etiological classification of Lymphedema
- Primary lymphedema
- hypoplasia lymphatics and lymph nodes
- hyperplasia lymphatics
- aplasia lymphatics and lymph nodes
- Secondary lymphedema
- damage or removal of regional lymph nodes through
surgery - Radiation of regional lymph nodes
- infection
- after traumas or tumor invasion or compression.
- vein stripping, peripheral vascular surgery
(arterial reconstruction) - liposaction
- burns, burn scar excision
- insect bites
5Treatment of Lymphedema of lower extremities
- Microsurgery
- Surgical resection
- Liposuction
- recommendations about change of a way of life
- skin care
- medicamentous treatment (benzopyrones,
antibiotics, and antifungal antibiotics) - compression by a low-stretch elastic stocking
- ?omplex physiotherapy
- pneumocompression
6Physiotherapeutic treatment of Lymphedema of
lower extremities takes leading positions in
Lymphedema treatment
- (2009 Consensus Document of the International
Society of Lymphology).
7clinical classification of lymphedema
(Savchenko T.V., Pokrovsky A.V., 2004)
- I stages latent or subclinical edema
- II stage - permanent (constant) edema
- III stage - increase edema with subdermal
fibrosis - IV stage - elephantiasis
8Actions of various physical factors
- stimulation of a lymphatic drainage
(strengthening methods to stimulate lymph flow
dynamics and lymphangion activity) - acceleration lymph transport
- stimulation extralymphatic factors of lymph
circulation (a muscular pump of a shin) - restriction lymph formation
- normalisation of processes of microvascular
circulation
9The primary goals of Complex Decongestive
Physiotherapy (CDT)
- 1. decrease edema
- 2. increase lymph drainage from the congested
areas - 3. reduce subdermal fibrosis
- 4. improve the skin condition
- 5. enhance patients functional status
10 In Center clinic we have developed and use
rehabilitation programs with the following
methods
- magnetic stimulation,
- magnetic laser therapy,
- pulse matrix laser therapy,
- cryotherapy,
- pneumocompression,
- balneotherapy (mineral baths and black mud),
- thalassotherapy (algotherapy with cold seaweed
application).
11Complex Decongestive Therapy(on method Foeldi M.)
- at 1 stage - a skin care, Manual Lymph Drainage
(MLD) and bandaging of the limb by bandage of a
short stretching, daily, physical exercises. - At 2 stage - (MLD) 2-3 times a week are carried
out, elastic support garment with the high
compression ( 4 classes of the compression), made
on individual measures of the patient to order
(MEDI, Germany).
12- Patient with Lymphedema III stage (Savchenko
T.V., Pokrovsky A.V.'s classification, 2004)
13At the I stage of Lymphedema
- recommendations about change of a way of life
- the elastic compression
- courses of medicamentous therapy once a year
(mainly in summer) - preventive and medical rehabilitation programs
(magnetic stimulation, a pneumocompression,
magnetic laser therapy, pulse matrix laser
therapy, balneotherapy, thalassotherapy),
14At the II stage of Lymphedema
- recommendations about change of a way of life,
- compression therapy,
- courses of medicamentous treatment are spent 2
times a year. - medical rehabilitation programs (a
pneumocompression, magnetic laser therapy, pulse
matrix laser therapy, magnetic stimulation,
cryotherapy, balneotherapy, thalassotherapy,
Manual Lymph Drainage and bandaging of the limb)
are spent 2 times a year.
15At the III stage of Lymphedema
- to change of a way of life,
- compression therapy,
- Medical rehabilitation programs (a
pneumo-compression, magnetic laser therapy,
magnetic stimulation, pulse laser therapy,
cryotherapy, balneotherapy, thalassotherapy,
Manual Lymph Drainage and bandaging of the limb)
are spent 2-3 times a year. - Medicamentous treatment is spent by courses for
4-6 months and includes preventive appointment of
the prolonged antibiotics for prevention of
relapses of an erysipelatous inflammation.
16At the IV stage of Lymphedema
- patients accept surgical treatment with carrying
out of conservative preoperative preparation and
postoperative rehabilitation with use specified
physiotherapeutic and medicamentous means.
17Patiens with IV stage of Lymphedema
18Patient with secondary Lymphedema II stage
(Savchenko T.V., Pokrovsky A.V.'s classification,
2004)
19Development Physibalneotherapy of lymphedema
in Russia
- Absence profile the special Lymphological centres
in Russia is compensated by an existing wide
network of branches of regenerative medicine and
Health Resort establishments. - At stages of regenerative and Health Resort
treatment patients with Lymphedema can spend
effective complex not medicamentous therapy with
application of a wide spectrum physiobalneotherape
utic methods.
20Conclusion
- Creation of modern rehabilitation programs of
regenerative treatment of patients with
Lymphedema has allowed to raise considerably
efficiency of conservative Lymphedema treatment
and to create necessary base for development in
Russia a physiotherapeutic direction in treatment
Lymphedema of lower extremities. -